JK v Department of Transport Infrastructure Development
[2009] NSWADT 307
•10 December 2009
CITATION: JK v Department of Transport Infrastructure Development [2009] NSWADT 307 DIVISION: General Division PARTIES: APPLICANT
RESPONDENT
JK
Department of Transport Infrastructure DevelopmentFILE NUMBER: 083297 HEARING DATES: 26 August 2009 SUBMISSIONS CLOSED: 3 September 2009
DATE OF DECISION:
10 December 2009BEFORE: Molony P - Judicial Member LEGISLATION CITED: Privacy and Personal Information Protection Act 1998
Health Records and Information Privacy Act 2002
Passenger Transport Act 1990
Passenger Transport Regulation 2007CASES CITED: KJ v Wentworth Area Health Service [2004] NSWADT 84 REPRESENTATION: APPLICANT
RESPONDENT
G Wright, barrister
M Allars, barristerORDERS: The Tribunal orders that the Ministry of Transport perform HPP1 and HPP2 with respect to its collection of personal information for the purposes of assessing the medical fitness of applicants for, and holders of, authorities to drive public passenger vehicles.
REASONS FOR DECISION
BACKGROUND
1 JK is bus driver who is required to submit a completed Medical Assessment Form in order to obtain a renewal of his authority to drive a public passenger vehicle. By letter dated "mayday 2008", received by the Ministry of Transport’s (‘the MoT’) on 12 May 2008, JK sought internal review of the MoT’s collection of data in its Medical Assessment Form, claiming that it was in breach of the Privacy and Personal Information Protection Act 1998 (‘the PPIPA’) and the Health Records and Information Privacy Act 2002 (‘the HRIPA).
2 A determination was not made within the 60 day period allowed by s 53(6) of the PPIPA. By letter dated August 2008 the MoT advised JK of his entitlement to proceed directly to review by the Tribunal. JK wished to seek review by the Tribunal, but also wished that a determination be made by the MoT.
3 By letter dated 29 September 2008 the MoT sent the internal review determination to JK. In summary, the internal review decided that there had been no conduct by the MoT in breach of Health Privacy Principle (HPP) 1, 2, 3, or 4.
4 On 10 October 2008 JK applied to the Tribunal for external review of that internal review determination.
5 The review was heard on 26 August 2009 when both parties were legally represented. By the time it reached hearing the issues had been narrowed to a consideration of whether there had been a breach of HPP1 and HPP 2.
6 HPP1 provides:
- ‘(1) An organisation must not collect health information unless:
(a) the information is collected for a lawful purpose that is directly related to a function or activity of the organisation, and
(b) the collection of the information is reasonably necessary for that purpose.
(2) An organisation must not collect health information by any unlawful means.’
7 HPP2 provides:
- ‘An organisation that collects health information from an individual must take such steps as are reasonable in the circumstances (having regard to the purposes for which the information is collected) to ensure that:
(a) the information collected is relevant to that purpose, is not excessive and is accurate, up to date and complete, and
(b) the collection of the information does not intrude to an unreasonable extent on the personal affairs of the individual to whom the information relates.’
8 The collection of information in issue is undertaken by use of a Medical Assessment Public Passenger Vehicle Driver.’ Below that heading is a paragraph which explains the purpose of the Form. It says:
- ‘The Ministry of Transport must be able to attest that all drivers of public passenger vehicles are fit and proper persons to hold an authority to drive such vehicles. This information is being collected in order to determine your fitness to drive a public passenger vehicle in accordance with the provisions of the Passenger Transport Act 1990 and Passenger Transport Regulation 2007. If the Director General cannot attest to you being a fit and proper person to hold an authority, the authority may be suspended, varied or cancelled or your application for authorisation may be refused. You have a right to request access to the information collected by contacting the appropriate Ministry of Transport office, the contact details are at the end of this form. The Ministry of Transport may disclose any health information received to another medical practitioner.’
9 The Form is in two parts: Part A, a ‘Patient Questionnaire’, and Part B, headed ‘Clinical Examination’. Part A is in blue print, with the rest of the Form being printed in black.
10 Part A contains the following instructions:
- ‘Patient Questionnaire - to be completed by the authorised driver or applicant for authorisation . Please answer the questions by ticking the correct box. If you are not sure, leave the question blank and ask your medical practitioner (doctor) what it means. You must then answer the question with your doctor. Your doctor will also ask you additional questions during the examination.’
11 It requires an applicant to provide his or her name, gender, residential and postal addresses, date of birth, drivers licence number, contact phone number, and particulars of any driver authority held now or on the past. It then has 12 questions which require answering. These are:
- Q1 - Are you being treated for any illness or injury? (Yes/No) If yes, give details.
Q2 – Are you taking any medications (either prescribed by your doctor or otherwise)? (Yes/No) If yes, give details (please list all medications currently being taken). Beside this are two boxes headed condition and medication.
Q3 – Do you use any drugs or medication not prescribed for you by a doctor which may affect your ability to drive a motor vehicle? (Yes/No)
Q4 – Do you have diabetes? (Yes/No) If yes, how is this being treated? (Diet/Tablets/Insulin)
Q5 – In the past year, have you ever had to pull off the road because you have become sleepy or drowsy? (Yes/No) If so how often?
Q6 – Have you ever had, or been told by a doctor that you had any of the following?
- a. High Blood Pressure (Yes/No)
b. Heart Disease (Yes/No)
c. Chest pain, Angina (Yes/No)
d. Any heart operation or procedure (Yes/No)
e. Palpitations/irregular heart beat (Yes/No)
f. Abnormal shortness of breath (Yes/No)
g. Head injury, spinal injury (Yes/No)
h. Psychiatric, Psychological, Nervosa Disorder or Depression (Yes/No)
i. Hearing Loss (Yes/No)
j. Seizures, fits, Convulsions, Epilepsy (Yes/No)
k. Blackouts, Fainting (Yes/No)
l. Stroke (Yes/No)
m. Dizziness, Vertigo (balance problems) (Yes/No)
n. Double Vision, Difficulty seeing (Yes/No)
o. Kidney disease (Yes/No)
p. Sleep Disorder, Sleep Apnoea or Narcolepsy (Yes/No)
q. Cancer (affecting brain or nervous system) (Yes/No)
Q8 – How many drinks do you have on a typical day when you are drinking? (1/ 2 / 3-5 / 6 or more)
Q9 – How often do you have six (6) or more standard drinks on one occasion? (Never / monthly or less / 2 to 4 times a week / 5 or more times a week)
Q10 – Do you use any illicit or recreational drugs? (Yes/No) If yes, give details
Q11 – Have you ever had any serious injury, illness, operation or been in hospital for any reason? (Yes/No) if yes, give details
Q12 – Have you been in a vehicle crash since your last medical examination? (Yes/No) If yes, give details.
12 An applicant is then required to sign and date a ‘Driver/Applicant declaration.’ It says:
- ‘I hereby declare that questions 1 to 12 inclusive on this Medical Assessment (Patient Questionnaire) have been read by me. The answers given to the questions in this Medical Assessment (Patient Questionnaire) form are, to the best of my knowledge, true, correct and accurate in every detail. I have listed all relevant details of my medical history.
I consent to my medical practitioner providing my health information to the Ministry of Transport, or to a medical practitioner nominated by the Ministry of Transport. Further, I give authority to the Ministry of Transport to obtain details of any matter which may assist in determining whether I meet the medical criteria outlined in the publication Assessing Fitness to Drive (Commercial and Private Vehicle Drivers) 2003.’
13 Part B of the Form is headed ‘Clinical Examination to be completed by your usual Medical Practitioner (General Practitioner or Family Doctor) ONLY from this point onwards.’ It begins with the following instruction:
- ‘To the Medical Practitioner - This medical examination must be conducted in accordance with the national medical standards prescribed in Assessing Fitness to Drive (Commercial and Private Vehicle Drivers) 2003. This publication is available from the web on . It details the examination process and provides examination Proforma to guide you. The standard for this examination is the commercial vehicle standards.’
14 It requires medical practitioners to provide their name, contact details and the date of the examination. It then contains 13 detailed questions which require the doctor to report their findings following examination with respect to the following matters:
- Q1- Head, Neck and throat Appearance
Q2 – Chest/Lungs
Q3 – Hearing without a hearing aid
Q4 – Hearing with a hearing aid
Q5 – Weight, Height and BMI
Q6 – Vision (in some detail)
Q7- Urinalysis
Q8 – Abdomen
Q9 – Whether a Neuropsychological Assessment is required
Q10 – Cardiovascular system – Blood pressure, pulse, heart sound and peripheral pulses
Q11 – Neurological / Locomotor – Cervical spine rotation. Back movement, upper limbs, lower limbs, Rombergs sign
Q12 – Alcohol or drug abuse – ‘signs of alcohol or drug abuse which may affect … ability to drive’
Q13 – Comments
15 The examining doctor is then required to complete a medical examination certificate which contains a number of options. It reads:
- I certify that I have examined in accordance with the relevant Commercial National Medical Standards as set out in the publication Assessing Fitness to Drive (Commercial and Private Vehicle Drivers) Medical Standards for licensing and Clinical Management Guidelines 2003.
In my opinion the driver/applicant:
- Meets the relevant criteria for an unconditional authority.
- Does not meet the criteria for an unconditional or conditional authority for the following conditions:
______________________________________________________
- May meet the criteria for a conditional authority for the following conditions:
______________________________________________________
To assess suitability for a conditional authority, I recommend either or both of the following actions
- - Referral to an appropriate medical specialist/s for completion of the Ministry's Medical Specialist Assessment Report (form) enclosed.
Note - The referring doctor should refer the applicant to a specialist/s of his/her choice and complete Part B of the Medical Specialist Assessment Report Form. Any costs involved are the responsibility of the driver/applicant. The completed Medical Specialist Report Form is to be returned to the Ministry of Transport.
-Referral for a practical driving assessment by either:
1. An accredited assessor for the type of vehicle involved (taxi, bus, 4wd or motor cycle), or
2. An accredited driver rehabilitation centre, or specialist (eg an occupational therapist)
Note- Accredited assessors can be suggested by the Ministry of Transport. Any costs involved in the assessment are the responsibility of the driver/applicant .
16 The last page of the Form is taken up with further instructions and information which include the following instruction the medical practitioner:
‘Distribute the completed certificate as follows :
- Provide the original certificate (together with additional information relevant to the patient's fitness to drive) to the patient for them to present to the Ministry of Transport.
- Retain a copy for the patient's medical record together with details examination notes.
- Information not relevant to the patient's fitness to drive should not be forwarded to the Ministry of Transport.’
17 It is not necessary to outline the balance of those instructions for the present purposes.
18 The Form was introduced in 2008, having been approved by the Director-General's delegate on 22 January 2008.
The Legislation
19 The HRIPA and the PIPPA - The HRIPA regulates dealings with health information by NSW public sector agencies and private organisations through the Health Privacy Principles. The HRIPA provides for the protection of the privacy of an individual's ‘health information’ that is held in the public or private sectors by reference to a set of health privacy principles which are contained in Schedule 1 of that Act.
20 The expression "health information" is defined in s 6 of the HRIPA. Section 6 relevantly provides:
- ‘In this Act, health information means:
(a) personal information that is information or an opinion about:
(i) the physical or mental health or a disability (at any time) of an individual, or
(ii) an individual’s express wishes about the future provision of health services to him or her, or
(iii) a health service provided, or to be provided, to an individual, or
(b) other personal information collected to provide, or in providing, a health service, or
(c) other personal information about an individual collected in connection with the donation, or intended donation, of an individual’s body parts, organs or body substances, or
(d) other personal information that is genetic information about an individual arising from a health service provided to the individual in a form that is or could be predictive of the health (at any time) of the individual or of any sibling, relative or descendant of the individual,
but does not include health information, or a class of health information or health information contained in a class of documents, that is prescribed as exempt health information for the purposes of this Act generally or for the purposes of specified provisions of this Act.
21 "Personal information" is defined in s 5 of the HRIPA.
22 It is agreed that the MoT collects, holds or uses health information within s 11(1) of the HRIPA, which provides:
- ‘(1) This Act applies to every organisation that is a health service provider or that collects, holds or uses health information.
Note. The term organisation means a public sector agency or a private sector person.
(2) An organisation to whom or to which this Act applies is required to comply with the Health Privacy Principles and with any health privacy code of practice or provision of Part 4 that is applicable to the organisation.
(3) An organisation must not do any thing, or engage in any practice, that contravenes a Health Privacy Principle or a health privacy code of practice or a provision of Part 4 in respect of which the organisation is required to comply.
Note. The application of Health Privacy Principles and the provisions of Part 4 may be modified by health privacy codes of practice. See section 39.’
23 The information sought by the Form in this case is health information within s 6(a)(i) and (iii) of the HRIPA. It follows that the MoT is required to comply with the HPPs set out in Sch 1 to the HRIPA with respect to that information.
24 Section 21 of the HRIPA provides:
- (1) The following conduct by a public sector agency is conduct to which Part 5 (Review of certain conduct) of the PPIP Act applies:
(a) the contravention of a Health Privacy Principle that applies to the agency,
(b) the contravention of a health privacy code of practice that applies to the agency.
(2) For that purpose, a reference in that Part:
(a) to personal information is taken to include health information, and
(b) to an information protection principle is taken to include a Health Privacy Principle, and
(c) to a privacy code of practice is taken to include a health privacy code of practice.
(3) …
25 Part 5 of the PPIPA contains the provisions of that Act which allow a person aggrieved by the conduct of a public sector agency to seek an internal review of that conduct (s 53(1)); the process to be followed in submitting, considering and determining an internal review (s 53(2) to (8)); the role of the Privacy Commissioner in that process (s 54); the right of a party aggrieved by an internal review to seek an external review in this Tribunal, and the powers of the Tribunal on external review (s 55); and, a right to appeal a decision of the Tribunal to an Appeal Panel (s 56).
26 The procedures for review under Part 5 of the PPIPA apply to the review of the MoT’s conduct under the HRIPA.
27 The orders that the Tribunal may make on external review are set out in s 55(2) of the PPIPA. It provides:
- ‘(2) On reviewing the conduct of the public sector agency concerned, the Tribunal may decide not to take any action on the matter, or it may make any one or more of the following orders:
(a) subject to subsections (4) and (4A), an order requiring the public sector agency to pay to the applicant damages not exceeding $40,000 by way of compensation for any loss or damage suffered because of the conduct,
(b) an order requiring the public sector agency to refrain from any conduct or action in contravention of an information protection principle or a privacy code of practice,
(c) an order requiring the performance of an information protection principle or a privacy code of practice,
(d) an order requiring personal information that has been disclosed to be corrected by the public sector agency,
(e) an order requiring the public sector agency to take specified steps to remedy any loss or damage suffered by the applicant,
(f) an order requiring the public sector agency not to disclose personal information contained in a public register,
(g) such ancillary orders as the Tribunal thinks appropriate.’
28 The Passenger Transport Act 1990 (the PTA) - A person who wishes to drive a public passenger vehicle, such as a bus carrying passengers, is required by s 11 of the PTA to hold an appropriate authority under Division 2 of Part 2 of the PTA.
29 The objects of the PTA set out in s 4 include:
- ‘(a) to require the accreditation or authorisation, by the Director-General, of the operators of and drivers involved in public passenger services (other than ferry services), and
…
(e) to encourage public passenger services that meet the reasonable expectations of the community for safe, reliable and efficient passenger transport services,
…’
30 According to subsection 11(2) of the PT Act, the purposes of an authority under that Division are to attest:
- ‘(a) that the authorised person is considered to be of good repute and in all other respects a fit and proper person to be the driver of a public passenger vehicle, and
(b) that the authorised person is considered to have sufficient responsibility and aptitude to drive the vehicle or vehicles to which the authority relates:
(i) in accordance with the conditions under which a public passenger service is operated, and
(ii) in accordance with law and custom.’
31 Section 12 of the PTA gives the Director-General of the MoT power to grant an authority to a person to drive a bus used to provide a public passenger service, and provides for the criteria to be applied, as follows:
- "(1) Having regard to the purpose of an authority, the Director-General may grant authorities to persons applying for them.
(2) Applicants must meet any criteria set forth in the regulations and must satisfy the Director-General as to any matter the Director-General considers relevant.
(3) Procedures for the purposes of this section may be settled by the Director-General, subject to any provision in that behalf made by the regulations.’
32 Under section 11B(1) of the PTA, an authority is subject to the conditions prescribed by the regulations, and such additional conditions as the Director-General, having regard to the purpose of an authority, may from time to time impose. Conditions imposed by the Director-General under s 11B(1)(b) may be varied from time to time by notice served on an authority holder (by reason of s 11B(2)). They may be varied by amendment, addition, revocation or suspension of one or more conditions. Failure to comply with a condition of an authority is an offence (s 11B(3)).
33 An authority is renewable from time to time (at periods determined by the Director General), unless sooner cancelled or revoked (see s 11A).
34 The function under s 12(1) of granting authorities is performed by the Director-General's delegates and authorised officers in the MoT.
35 Reg 29 of the Passenger Transport Regulation 2007 (the PTR) specifies criteria for the purpose of a 12(2). Included in the criteria is a requirement that the applicant ‘must have passed an examination or assessment, at a level determined by the Director-General, in medical fitness’ (reg 29(2)(d)).
36 For bus drivers under the age of 60 reg 98 of the PTR provides:
- ‘The driver of a bus must, at the driver’s own expense, furnish the Director-General at intervals of 36 months until the driver attains the age of 60 years with a certificate from a medical practitioner containing the medical practitioner’s assessment, in accordance with any requirements of the Director-General, of the driver’s medical condition.
Maximum penalty: 10 penalty units.’
37 For those 60 years and older reg 47 provides:
- ‘(1) On attaining the age of 60 years and from then on at intervals of 12 months, the driver of a public passenger vehicle must, at the driver’s own expense, furnish the Director-General with a certificate from a medical practitioner containing the medical practitioner’s assessment, in accordance with any requirements of the Director-General, of the driver’s medical condition.
Maximum penalty: 10 penalty units.
(2) The Director-General may, by notice in writing, require a driver of a public passenger vehicle to attend a medical practitioner specified in the notice, by a date specified in the notice, for the purposes of undergoing a medical fitness examination.
(3) The driver of a public passenger vehicle must (in so far as the driver is capable of doing so) furnish the Director-General, within 48 hours after any change in the physical or mental condition of the driver of which the driver is aware that may affect the driver’s ability to drive public passenger vehicles safely, with written details of the change.
Maximum penalty: 10 penalty units’
38 The Director-General has adopted a number of relevant policies and procedures.
39 First, in the exercise of the discretion under reg 29(2)(d) to set levels of fitness, the Director-General has adopted the Assessing Fitness to Drive (Commercial and Private Vehicle Drivers) Medical Guidelines 2003 (the AFTD Guidelines). These contain medical standards developed by the National Road Transport Commission (now the National Road Commission), following consultation with all driver licensing authorities across Australia, and with health professionals, relating to fitness to drive for licensing purposes. They were first adopted on 24 March 2003.
40 Secondly, on 17 November 2006, the Director-General adopted MoT Public Passenger Vehicle Medical Assessment Procedures (the PPVMA Procedures). These set out the procedure for obtaining a medical assessment, identify the specialist requirements where the applicant has a medical condition, and annex in Appendices 2 and 3 the medical assessment standards to be applied by the assessing medical practitioner.
41 Thirdly, the Form, which was approved by the Director-General's delegate on 22 January 2008. It provides a more detailed structure for the assessing medical practitioner than did the form previously used by the MoT. This change was prompted by a report on a serious bus collision on the Spit Road in 2005. It recommended that the MoT strengthen its system of monitoring adherence to health assessment regimes, including by introducing thorough and timely reviews of medical assessments of drivers holding authorities.
Material before the Tribunal
42 Among the material before the Tribunal was an affidavit from JK in which he said he had been required to obtain a doctors medical certificate, in relation to his fitness to drive a public passenger vehicle, when he applied for his driver authority in July 2003. When his authority came up for renewal in 2006 he underwent a further examination. The medical certificates he was then required to provide to the MoT ‘did not contain any details as to my medical background, such as health services which have been provided to me.’ In January 2008 he became aware of the information collected by the new Form. He though it required personal information ‘that was not relevant to my fitness to drive public buses.’ JK made specific reference to Question 11 of Part A which he interpreted as, ‘requiring me to disclose details of any period of hospitalisation whether it be as an outpatient or inpatient and every operation that I have received, as well as details of every serious illness or injury.’ With respect to the ‘Driver/Applicant declaration’ he said that, ‘it did not occur to me and I was not aware, that I was not required to provide the consents set out in that section.’
43 There were two affidavits filed by the MoT. The first from Mr David Tooze, the Acting General Manager Regulation and Compliance at the MoT. It is essentially a formal affidavit annexing the Form, the AFTD Guidelines and other documents.
44 The second affidavit is from Dr Michael Garvan, an occupational and environmental physician contracted to the MoT. He works with two registered nurses assessing the information provided in completed Forms. He explains that:
- ‘6. The assessment process which I undertake, together with the two registered nurses employed by the Ministry for this purpose, involves checking the information in the completed Forms against the Guidelines. In my experience, in most cases in which a General Practitioner has indicated that a person meets the relevant criteria for an unconditional authority, the Practitioner's assessment is inaccurate because the information provided on the form does not meet the requirements of the Guidelines.
7 Nonetheless, the information provided in the Form by a General Practitioner is useful because a treating General Practitioner is more familiar with an applicant's medical history than is another practitioner who may be more familiar with the Guidelines, but who is not familiar with an applicant's medical history.
8 An example of a problem that sometimes arises with treating practitioners who certify the applicant as being eligible for an unconditional authority contrary to the Guidelines is where the applicant suffers diabetes. In those cases, sometimes the General Practitioner believes that they are appropriately treating the applicant's diabetes and accordingly the applicant is eligible for an unconditional license. However, the Guidelines require that a person suffering from a particular type of diabetes not entitled to an unconditional authority but must undergo at least an annual medical review.
9 After an assessment of the Form is completed, some drivers are granted an authority subject to conditions. The majority of conditions imposed relate to the frequency of medical reviews. An unconditional authority holder is only required to undergo a review every three years, whereas a person with a conditional authority may be required to undergo an assessment every 6 or 12 months. A small percentage of applicants are referred to a specialist medical practitioner for assessment. Very few applicants have their application for an authority/renewal declined on the basis of the information in the Form.
10 The information collected by the Form enables the assessment to be carried out to ensure that drivers meet the criteria set out in the Guidelines. Drivers incorrectly certified are a risk to public safety when they drive a public passenger vehicle. The average age for the holder of public passenger authorities is 49.01 and statistically people around that age are more prone to medical conditions that may affect their ability to operate a public passenger vehicle than younger people may be. Additionally, over fifty per cent of drivers are over the age of 50 years.’
45 Dr Garvan then addresses the Form. He notes that the questions in Part A are ‘largely modelled on the sample questionnaire’ in the AFTD guidelines. This is largely correct, although there is no equivalent of question11. He then goes through each question explaining its rationale and use. Essentially, he says that the questions are designed to illicit information which may be relevant to an assessment of an applicant’s fitness to drive a public passenger vehicle. Three examples of his comments will suffice:
- ‘Question 3: This question is intended to capture whether the applicant is taking any herbal medicines or pharmacy medicines or illicit drugs. Any positive response is then assessed to determine whether the drug may affect a person's ability to operate a public passenger vehicle.
…
Question 6: These questions are designed to tease out any issues that might be of concern to a doctor assessing an applicant against the Guidelines.
…
Question 11: This question is designed to capture any information that might be relevant to the assessment that is not otherwise provided in the Form. It is important, because a patient may not know the significance of the information that they are providing and if they self censor in the information that is provided, they may eliminate information that is relevant to whether they are fit to drive a public passenger vehicle. Only a medical practitioner is able to assess what information might be relevant to whether a person can operate a public passenger vehicle.’
46 With respect to Part B of the Form Dr Garvan outlines what the questions are designed to capture and the relevance of that information to the assessment of fitness to drive a public passenger vehicle.
47 The AFTD Guidelines are a 130 page document. They extend beyond the setting of medical standards for fitness to drive. They include clinical management guidelines and policies and procedures for to be followed in undertaking medical assessments relating to fitness to drive. The medical assessment procedures envisaged by the AFTD Guidelines do not envisage that the information provided by an applicant in completing the questionnaire (or that resulting from the medical examination) being disclosed to the licensing authority in all circumstances. Rather, the AFTD Guidelines establish a procedure whereby the medical practitioner retains those documents, and issues a separate certificate. That certificate indicates whether the criteria are or are not met. Insofar as they are not met, details are to be given ‘as well as details of recommended restrictions and monitoring requirements for a conditional licence.’ Importantly, the AFTD Guidelines state at paragraph 3.3.1 that, ‘Medical information not relevant to the patient’s fitness to drive should not be included in this form for privacy reasons.’ At paragraph 3.3.4, the AFTD Guidelines recommend that if the licensing authority wishes to obtain details of the medical examination, ‘this should follow discussions with the State and Commonwealth Privacy Commissioners and the State/Territory branch of the Australian medical Association.’
48 The Privacy Commissioner participated in the planning meetings relating to this matter, but not the hearing. At those planning meeting the Privacy Commissioner’s representative confirmed that no approach had been made to the Privacy Commissioner about the Form by the MoT.
49 The PPVMA Procedures were issued by the Director-General and are dated 17 November 2006. They outline procedures to be followed in assessing the medical fitness of applicants for, and current holders of, driver authorities. They adopt as ‘minimum standards for assessing medical fitness of drivers’ those in the AFTD guidelines. They require medical assessments to be undertaken by a qualified medical practitioner and for the Form to be completed by both the applicant and the medical practitioner.
50 The PPMVA Procedures provide for a review of completed Forms by the MoT (at p. 5):
- ‘The Ministry of Transport must review the information contained with the medical assessment forms and make a determination as to whether the driver/applicant meets the requirements of the relevant medical standards. In making this determination, Ministry Officers must give consideration to the following:
- - The recommendation made by the assessing Medical Practitioner
- Any supporting information provided with the medical assessment forms, including specialist reports
- Any relevant information contained within the driver's file, particularly the medical history of the individual concerned
-Any relevant advice from the Ministry's Chief Medical Officer (CMO)
- Any other relevant information that may be available to the assessing officer in relation to driver's medical condition. This may include reports from the NSW Police, the NSW Roads & Traffic Authority, the driver's employer and the public (complaints, incidents etc)
Where the Authorities Officer has any doubt in relation to the driver's medical condition, the advice of the Ministry's CMO must be sought.
Drivers/applicants who make false declarations in relation to their medical condition are liable for these declarations, which can include prosecution and loss of their Authority.’
51 The PPMVA Procedures make further provision with respect the obligations of holders of driver authorities with respect to medical assessments (at p.9):
- ‘Holders of public passenger vehicle Driver Authorities have a number of obligations placed upon them, in relation to medical assessments. These include:
- - Providing the assessing Medical Practitioner and medical specialist with all relevant information in regards to their medical health;
- Advising the Ministry of the development of any medical condition that may have an impact on their ability to drive a public passenger vehicle;
- Provide completed medical assessment forms by the required date.
52 Also among the material before the Tribunal is the report of the Office of Transport Safety Investigation into the STA Bus Collision at Spit Road, Mosman (the Report) on 14 November 2005. The MoT says that the introduction of the Form was prompted by recommendations in the report, ‘that the MoT strengthen its system of monitoring adherence to health assessment regimes, including by introducing thorough and timely reviews of medical assessments of drivers holding authorities.’
53 The Report found that at the time of the Spit Road accident the bus was in an ‘inappropriate gear’ and driven at an excessive speed to that required to safely negotiate the road. The driver ‘exhibited signs of reduced concentration prior to the accident and may have suffered a micro-sleep’ and ‘was not wearing a seat belt..’ These factors combined to lead to the accident. The report found that (at p.34):
- ‘i.) In 1996 and on two occasions in 1997, the Driver had collapsed in his seat whilst his bus was stationary, but that subsequent medical examinations failed to identify any medical condition that might have triggered these collapses. Further medical examination following the accident on Spit Road also failed to identify any medical condition that might have induced fatigue or a collapse.
ii.) MoT was aware of the three incidents where the Driver was found collapsed in his seat and had suspended his authority to drive a public passenger vehicle after the second and third instances, but lifted its suspensions following receipt of medical advice which indicated that the Driver was fit to perform his duties.
iii.) The second restoration of the Driver's authorisation to drive a public passenger vehicle was conditional upon the Driver submitting to an annual, rather than a bi-annual, health assessment, but that MoT did not notify his employer (…) of this requirement.
iv.) MoT did not insist on, nor follow-up, its own stipulation that the Driver be required to submit to an annual health assessment and that the assessments that were conducted in 1997, 1999, 2001 and 2004 were undertaken by the Driver's doctor. In each instance, that part of the health assessment documentation requiring the Driver to declare whether he had ever fainted or blacked-out was completed in the negative.’
54 The Report recommended that the MoT:
- ‘i.) Review its system of monitoring adherence to the health assessment regime.
ii.) Review its system of monitoring compliance with any special conditions attached to a driver's authorisation.
iii.) Ensure that it maintains an independent capability to conduct thorough and timely reviews of medical assessments of drivers holding, or seeking to hold, a Public Passenger Vehicle Driver's Authority.
iv.) Cancel the Bus Driver's Public Passenger Vehicle Driver's Authority and ensure he is not re-authorised.’
Issues
55 JK contends that the Form involves a collection of a broad range of health information relating to an applicant in order to obtain an authority (or renewal of an authority) to drive a public passenger vehicle under the Passenger Transport Act 1990 (the PTA). He contends that the information collected in Parts A and B of the Form is not reasonably necessary for the purpose of assessing a driver's medical fitness to drive and is excessive. He contends that the procedures requiring the disclosure of that information (apart from the Medical Certificate ) to the MoT is not reasonably necessary for the purpose of assessing a driver's medical fitness to drive and is excessive.
56 He argues that ‘Driver/Applicant declaration’ is ‘bundled consent’ which requires, at the one time, an applicant:
- - to declare that the information provided in response to the patient questionnaire is true and correct and at the same time;
- to acknowledge that he or she has ‘listed all relevant details of my medical history’;
- to consent to the applicant's medical practitioner to provide ‘my health information to the Ministry of Transport or to a medical practitioner nominated by the Ministry of Transport’.
- give authority to the Ministry of Transport to obtain details of any matter which may assist in determining whether I meet the medical criteria outlined in the publication Assessing Fitness to Drive (Commercial and Private Vehicle Drivers) 2003.
57 JK contends that the combination of these declarations and consents into one has the practical effect of requiring an applicant to give the consents provided, without there being any requirement that he or she do so. The Form, it is argued, does not provide for the required declarations to be made, but the consent withheld.
Is the collection of Parts A and B of the Form reasonably necessary?
58 JK submits that the collection by the MoT of the information in Parts A and B is reasonably necessary for the purpose of determining whether the Director General is satisfied that the applicant meets the criteria for an authority (or renewal of such). JK says that the previous system, as favoured by the AFTD Guidelines, did meet the standard set out in HPP 1.
59 Subject to what is said below about Question 11 of Part A of the Form, the broad thrust of this submission must fail.
60 The purpose for which the MoT collects all the information is to assess the fitness of persons who seek to be authorised to drive public passenger vehicles. This is a lawful purpose. It is recognised by and consistent with the objects of the PT Act. Amongst the objects of the PT Act are the authorisation by the Director-General of the drivers involved in public passenger services, and encouraging public passenger services that meet the reasonable expectations of the, community for safe, reliable and effective passenger transport services.
61 The Act and Regulations establish a scheme whereby the Director-General is required to be satisfied that authority holders satisfy the criteria specified in the regulations and that which the Director-General considers relevant (s 12). This includes satisfying the Director-General’s requirements as to medical fitness (Reg 29(2)(d)). Importantly, it is the Director-General who is to be satisfied that the criteria are satisfied.
62 The lawful purpose for which the information sought in the Form is collected, namely assessing the medical fitness of persons who seek to be authorised to drive public passenger vehicles, is a purpose directly related to the Director-General's functions under s 12.
63 When one compares the questions asked in Part A, except for questions 11, and the examination details contained in Part B of the Form with the Medical Standards in Part B with the AFTD Guidelines, there is an obvious and direct correlation between the standards and the information sought to be elicited by the Form. The questions asked, and the examination to be conducted by a medical practitioner, are clearly referrable to criteria outlined in the AFTD Guidelines. For example, the questions relating to diabetes are directly referable to the standards in section 5 of Part B, as the questions relating to drinking behaviour are consistent with Part 1.2 of the standards.
64 The exception to this in my view is question 11 of Part A of the Form. This asks:
- ‘Have you ever had any serious injury, illness, operation or been in hospital for any reason? Yes No If yes, give details.’
65 JK submitted that this question is too wide and requires the provision of information which may be irrelevant to the assessment of an applicant’s fitness to drive a public passenger vehicle. JK argued that it requires the provisions of details relating to every hospital attendance (in patient or out patient) irrespective of its relevance to fitness to drive. JK posited, as an example, that it would require disclosure of a vasectomy.
66 The MoT argued that the Form - by instructing the examining medical practitioner that information not relevant to fitness to drive should not be forwarded to the MoT – did not collect irrelevant information. This is not apparent from the Form. Question 11 is in Part A which is to be completed by the applicant, not the medical practitioner, and is the subject of a declaration as to it accuracy by the applicant. There is no indication in the Form that the medical practitioner is free to edit irrelevant information from Part A. It impresses me as a remarkable that the MoT would suggest that a medical practitioner is free to excise information that an applicant has declared to be correct. I do not accept that the instructions relating to the removal of irrelevant material refer to Part A of the Form, or that they have the effect contended by the MoT.
67 The MoT argued that question 11 was relevant to an assessment of whether an applicant meets the standards in the AFTD guidelines. While it may be that question 11 will capture information relevant to the standard, it casts such a wide net that, in my opinion, it unreasonably requires an applicant to disclose information which has no relevance to the standards. The question is not in any limited in its scope to the standards or to an applicant’s fitness to drive.
68 In his affidavit Dr Garvan said that question 11 was intended to capture information that might otherwise not be disclosed. Given the breadth and comprehensiveness of the rest of the patient questionnaire, and the detailed nature of the medical examination, it would be surprising if such information was not otherwise captured.
69 Dr Garvan made the point that, ‘Only a medical practitioner is able to assess what information might be relevant to whether a person can operate a public passenger vehicle.’ This is to be contrasted with the implicit faith in an applicant’s ability to gauge the effect of non-prescription medication on his or her ability to drive found in Question 3. It asks, ‘Do you use any drugs or medication not prescribed for you by a doctor which may affect your ability to drive a motor vehicle?’ Question 3, unlike question 11, is not at large but has as its focus fitness to drive. It entrusts applicants with a degree of judgement in assessing whether non-prescription medication may affect fitness to drive, and does not require applicants to list every non-prescription medication they take. Dr Garvan said of it that, ‘Any positive response is then assessed to determine whether the drug may affect a person's ability to operate a public passenger vehicle.’ This reliance on an applicant to determine which non-prescription drugs may affect ability to drive, is to be contrasted with Dr Garvan’s assertion, with respect to question 11, that only a medical practitioner is able to assess what information might be relevant.
70 There is no doubt that question 11 casts a very wide net. I accept that it is designed to capture information in relation to any serious injury, illness, operation which an applicant has ever had, irrespective of its relevance to medical fitness to drive a public passenger vehicle. JK’s example of a vasectomy is apposite. I also agree with JK that, on its face, question 11 seeks details of every time an applicant has been in hospital, whether as an inpatient or out patient, irrespective of the relevance of that information to fitness to drive. These requirements are in my opinion not reasonably necessary for the purpose of determining whether an applicant meets the medical fitness criteria determined by the Director-General. Requiring applicants to answer question 11 is therefore a collection of information that is not reasonably necessary for the MoT’s purpose and is in breach of HPP1.
71 The collection of the balance of the information, apart from that in question 11, is reasonably necessary for the purpose of assessing the fitness of persons who seek to drive buses. That information is referrable to the standards in the AFTD guidelines adopted by the Director-General. The Form, apart for question 11, is designed to obtain information relevant to s 12(2), reg 29(2)(d) and the AFTD Guidelines.
72 Under the PPVMA Procedures the information is collected directly from applicants. The collection is of that information, aside form that in question 11, is therefore reasonably necessary.
73 JK’s submission that the collection of the information is not reasonably necessary because the procedures set out in the AFTD Guidelines, whereby information equivalent to that found in Parts A and B of the Form (excluding the medical certificate) are to be preferred, must also fail.
74 This is so because the scheme of the PTA requires that the Director-General be satisfied that an applicant has passed a medical examination at a level determined by the Director-General. For that purpose the Director-General has, in the PPVMA Procedures, adopted a procedure whereby the Form is submitted to the MoT, so that the Director-General can be satisfied that the criteria have been met. The procedures set out in the AFTD Guidelines are not binding on the Director-General. While the Director-General has adopted the medical fitness standards set out in the AFTD Guidelines, the Director-General has established different procedures to be followed in determining compliance with those standards. That is something the PTA and the Regulations expressly authorise him to do.
Does the Form collect excessive information?
75 JK submitted that question 11 is too wide and requires the provision of information which may be irrelevant to the assessment of an applicant’s fitness to drive a public passenger vehicle. JK argued that it requires the provisions of details relating to every hospital attendance (in patient or out patient) irrespective of its relevance to fitness to drive. JK posited, as an example, that it would require disclosure of a vasectomy.
76 I have already found that the collection of the information in question 11 is not reasonably necessary. I consider it excessive for the same reasons.
The Bundled Consent issue
77 Both parties made submissions in relation to the bundled consent issue. As the ALRC pointed out in ALRC Report 108, For Your Information – Australian Privacy Law and Practice at Chapter 19 – Consent, consent is not a privacy principal in itself. It is relevant to the operation of some privacy principles, and can provide legal authority for an agency to deal with health or personal information in a particular way: e.g. see s 11 of the HRIPA.
78 While consent is required before an agency can deal with information in various ways, neither the PIPPA nor the HRIPA regulate how such consent is to be obtained. Under the general law such consents must be both freely given and informed. Section 72 of the HRIPA, however, contains express provisions prohibiting the use of threats, intimidation or false statements when obtaining consents required under the Act.
79 Whether any given consent will operate to satisfy the consent requirements will depend on the construction of the consent itself, the circumstances in which was given, and the understanding of the person giving consent, taking into account their particular vulnerabilities. It is not a simple matter.
80 The issue of bundled consents is also not expressly dealt with by the legislation. The ALRC in Report 108 which the competing arguments for and against the bundling of two or more consents together.
81 In JK’s case both parties have made submissions going to the procedure adopted by the MoT in bundling both a declaration and two consents together. I do not intend to traverse those arguments in any great detail, because I have not been asked to make any specific orders or findings with respect to the ‘Driver/Applicant declaration.’ Rather JK, in his final submissions, raised issues and questions concerning the procedure adopted by the MoT, but made no submission that there was any conduct in breach of a HPP or the a code of practice, and did not claim any specific relief or remedy in that regard.
82 He argued that the Declaration contains two sentences by which the applicant provides consent for the applicant's medical practitioner to provide "my health information to the Ministry of Transport or to a medical practitioner nominated by the Ministry of Transport". It is, I think, important to note that this first consent is not, in its terms, limited to the provision of information relevant to matters relevant to fitness to drive. The declaration then goes on to give authority for the MoT to obtain details of any matter "which may assist in determining whether I meet the medical criteria outlined in the" AFTD.
83 In reply, the MoT took issue with certain assertions made by JK, and submitted that applicant’s free to sever the consents from the declaration. I doubt that it would be apparent to an individual completing the patient questionnaire in Part A that he or she is free to delete the second paragraph of the ‘Driver/Applicant declaration.’ Indeed, the PPVMA procedures with respect to driver obligations tend to suggest the contrary.
84 JK submits hat onus is on the MoT to clarify the requirements of disclosure so that applicants are aware that there is no obligation to provide the consents contained in the Form. While the matter has not been fully ventilated before me I have reservation about whether such clarity is available when consents are combined with a required declaration, as occurs here.
85 In the circumstances, I am inclined to echo the words of Montgomery JM in KJ v Wentworth Area Health Service [2004] NSWADT 84 where he said, when asked to make a ruling about a proposed consent form, at [62].
- ‘It is not for the Tribunal to dictate to the Agency the procedures it should adopt so as to ensure that there is compliance with the Privacy Act . These procedures should be developed after careful consideration by the Agency’s administrators in consultation with an appropriate ethics committee and client representative. This process is beyond the practical scope of the Tribunal’s functions, if not beyond its jurisdiction. In the circumstances, it is my view that the matter should be given further consideration by the Agency so as to ensure that any procedures it adopts will ensure that it can comply with the requirements of the Privacy Act and that any consent provided by its clients is informed consent.’
86 In my opinion as no breach of a HPP or of a health privacy code of practice was was alleged at hearing by JK with respect to the bundled consent, the Tribunal should not rule on these issues. They are nonetheless important. That is why I have canvassed the arguments.. While I make no findings on this issue, I commend to the MoT’s advisers Chapter 19 of ALRC Report 108, and suggest they contemplate how the giving of free and informed consent can be coupled with the making of a required declaration in a licensing process.
Relief sought
87 In summary I have found that question 11 of Part A of the Form collects information which is not reasonably necessary for the purposes of assessing driver medical fitness under the Passenger Transport Act 1990 and is excessive. I have found that the other information collected by the Form is reasonably necessary for the purpose and not excessive.
88 I have expressed my concerns in relation to the ‘Driver/Applicant declaration’ but have made no finding in relation to them.
89 In submissions JK suggested a number of remedies.
- ‘1 The applicant seeks orders:
- a) requiring the MoT to refrain from further collecting Parts A and B of the Medical Assessment Public Passenger Vehicle Form in contravention of HPP 1 and/or HPP 2;
b) requiring the performance of HPP 1 and HPP 2 by the MoT.
90 Given my findings I propose to make orders that the MoT perform HPP1 and HPP2 with respect to its collection of information for the purposes of assessing the medical fitness of applicants for, and holders of, authorities to drive public passenger vehicles.
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